Should you choose a cloud-based electronic document management system or an on-premise one?

Nearly three years ago, Kirk Graham needed a solution. Graham, the IT director for American Outcomes Management (AOM), had his hands full. Paperwork for the nationwide home IV therapy provider was getting more challenging to manage. The provider was running out of space to store important paperwork and was using remote space for storage, making it harder to retrieve paperwork that was needed. Field staff was late in returning paperwork, oftentimes causing delayed medical follow up and billing. Patient privacy was potentially being compromised.

Modern electronic medical records (EMRs) are extremely effective at managing point-of-care documentation. But what about the rest of the documents – paper and otherwise – that are generated every day in a healthcare facility?

There are lab reports, consultations, referrals and legal paperwork to be attached to patient records. And then there’s everyday back-office administrative files from accounts payable and human resources. An EMR system can’t keep all that straight. Implementing a robust infrastructure can help companies provide efficient services, allowing for business to be conducted in a more timely manner. Especially in the medical and healthcare industries, collaborative solutions can help streamline business processes, allowing more time to concentrate on patient care.

With offices in Fort Worth, Texas, and New York City, AOM’s patient charts were spread between both offices and its departments. When its field nurses conducted home visits, they were required to document the treatment provided to patients. Up until last year, this information was recorded on paper forms, which were later turned into the home office and routed manually to the appropriate departments. This became very labor intensive and was inefficient. AOM required a solution that would allow its field nurses, independent of their location, to access their entire patient chart at their offsite location. They also wanted a way to cut down on the costs of paper and printing, and the time of maintaining a paper environment. The company's Texas location was already taking up two rooms filled with patient charts.

But what were the considerations Graham needed to make in order to take AOM paperless? What did he need to think through in making a decision about whether to choose a cloud-based electronic document management system (EDMS) or an installed, on-premise system housed on a company server?

On-premise systems

On-premise document management systems – systems for which you buy paperless office software to add to your own system and infrastructure – are ideal for small and mid-size firms that have some in-house IT support and back-up servers to provide an extra level of security. They’re also a good fit for those firms that aren’t quite comfortable with storing their sensitive data on the cloud – and for those that are waiting to see how effective cloud-based security systems really are.

Cloud systems

On the other hand, cloud systems, like Cabinet’s SAFE CLOUD, have a few major advantages over on-premise systems. These include reduced in-house server costs, faster implementation and deployment times, hassle-free backup and disaster recovery, and easier multi-site and remote access.

In addition, the paperless cloud option provides less hardware upkeep and peace of mind for business owners in the wake of natural disasters. Their in-office equipment isn’t compromised and their sensitive documents are kept safe, which translates to dollars and time saved in getting back to business as usual.

Evaluating the solution

No matter what route a company decides to take – out of the box or in the cloud – there are three major benefits to managing documents virtually: increased efficiency, tight security and immediate accessibility.

There are also a few standard questions you should ask as you research a third-party electronic document management provider. These include:

  • Is the paperless office solution configurable? Is the new electronic document management software designed to work with your current software? Does the paperless workflow in the solution interface well with your workflow? Any new system comes with a learning curve. It’s important that the solution be as configurable as you need it to be.
  • If you’re going paperless in the cloud, how often is information backed up?
  • If you’re choosing a hard install of on-premise electronic document management software, how often is the software upgraded? What are the fees associated with an upgrade? Is there a yearly maintenance and support fee?
  • For cloud-based paperless office solutions, what is the subscription fee to use the service? What does the fee schedule look like? Is it per year, per person or both?
  • Is the paperless office solution scalable? Will it accommodate your business as it grows? If so, what are the fees for extra/additional seats?
  • Does the electronic document management solution offer a mobile application? People need instant accessibility to key documents on the go. It’s important that a paperless office solution specialist be in step with this need and provide a solution to make it happen.

Putting a solution to use

After doing due diligence in researching possible solutions for American Outcomes Management, Graham turned to Cabinet SAFE's user-friendly interface. The solution streamlines user tasks by moving manual paper-based procedures into efficient, automated workflow processes, eliminating the need for paper. It consolidates all information into one organized and easy-to-use system, allowing instant document filing and extensive management tools.

“The interface was very user friendly and less scary than the others we looked at,” says Graham. “SAFE was also more customizable and affordable with comparable features.”

Additionally, Cabinet collaborated with LincWare, an e-forms provider, to provide AOM with a complete solution. Now, AOM uses the Apple iPad, SAFE and LincWare’s e-forms program to help improve its day-to-day business operations and patient care.

“We wanted to eliminate the paper forms, expedite data entry and improve accuracy by eliminating the handwritten information,” says Graham. “Cabinet was able to help us meet these expectations.”

Cabinet and LincWare pull data from AOM’s medical application called CPR+ for indexing and workflow routing purposes. Since LincDoc Mobile runs on the iPad, a field nurse can choose the type of form to fill out (including supply request forms, expense reports, medication profiles, visit records and even verifications with insurance companies) and complete all of the necessary information on site. LincDoc pulls the pertinent information from either the CPR+ database for patient information, the Cabinet database for HR (expense, mileage) or Pump (maintenance) related documents. Once the form is completed and submitted, Cabinet imports and saves the document into the Patient, Employee, or Pump chart. Then, based on the type of document or certain fields in the form, it will submit the document into workflow.

Since using Cabinet's suite of products, including SAFE and MOBILE, Graham can rest a little easier. Selecting Cabinet over other providers was a clear choice for him, because he knew that nurses and field staff unfamiliar with the latest in technology would be able to quickly adapt and understand the interface: It resembles other programs they'd likely use, it wasn't techy and it was straightforward and intuitive.

Now AOM nurses are using iPads to instantly transmit paperwork from the road, getting it into the hands of the appropriate people for follow up and follow through. Turnaround time, says Graham, is “down to a minute” as opposed to the days and sometimes weeks it had previously taken.

Even incoming faxes are synchronized. Incoming faxes are changed to a TIFF format, then to a PDF and forwarded to the processors’ desks. No more finding a fax on a machine and walking it around, department by department, to be scrutinized, understood and routed to the right place.

Graham says since the implementation of Cabinet, workflow processes have completely changed – for the better.

By using these technologies, AOM has gained benefits such as:

  • Billing efficiency – the ability to bill for nursing visits in minutes rather than weeks or months.
  • Organization – everything is filed electronically vs. multiple rooms filled with paper documents and filing cabinets.
  • Forms are more legible in a digital format – no need for verification or explanation due to illegible handwriting.
  • Improved workflow – data collected by the nurses is input electronically, streamlining billing and patient medical chart maintenance.
  • Savings in time and money – cost savings on paper, toner and time spent on maintaining paper charts. AOM has sped up its ability to bill for visits by weeks versus months.

About the author

Andrew Bailey is president, Cabinet Document Management Solutions. To learn more, go to